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See a sample rate comparisonCPT 21196 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Andor Body Sagittalsplit With Internal Rigid Fixation Reconstruction Of Mandibular Rami Andor Body Sagittal
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 80 - Assistant surgeon 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 21196 |
| Medicaid Fee Schedule | View Medicaid rates for 21196 |
National average reimbursement for CPT 21196 by major payers:
$1,762.75
$1,939.21
$2,082.72
$2,372.82
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CPT 21196
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Hurst-Euless-Bedford
$13,172.00Published rateCamp Lowell Surgery Center,LLC, Camp Lowell Surgery Center
Camp Lowell Surgery Center
$5,249.00Published rateWomen'S Surgical Center
Womens Surgical Center
$2,500.00Published rateWeir Asc, LLC, Southwest Eye Surgery Center
Weir Asc LLC
$1,700.00Published rateCentral Florida Eye Institute Pl
$702.22Published rate
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See a sample payer proposalCPT 21196 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21196 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 21196 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 21193-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Horizontal Vertical C Or L Osteotomy Without Bone Graft Reconstruction Of Mandibular Rami Horizontal Vertical C |
| 21194-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Horizontal Vertical C Or L Osteotomy With Bone Graft (Includes Obtaining Graft) Reconstruction Of Mandibular Rami Horizontal Vertical C |
| 21195-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Andor Body Sagittalsplit Without Internal Rigid Fixation Reconstruction Of Mandibular Rami Andor Body Sagittal |
| 21196-CPT | High | Reconstruction Of Mandibular R, Reconstruction Of Mandibular Rami Andor Body Sagittalsplit With Internal Rigid Fixation Reconstruction Of Mandibular Rami Andor Body Sagittal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21196. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21196 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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